Overview of federal initiatives in suicide prevention

Introduction

The Government of Canada works with its partners to promote and protect the health of Canadians, including newcomers. It plays an important role in suicide prevention in a variety of ways — by supporting programs that improve mental health and well-being and prevent suicide, conducting surveillance on suicide, and conducting and funding research to better understand suicide. The federal government provides or funds mental health care services for specific population groups.

Other partners play critical roles in suicide prevention. Provinces and territories provide health care services and supports, including crisis intervention, diagnosis and treatment. Non-governmental organizations serve as frontline agents in the provision of helpline and crisis management, as well as supportive counselling. Some of these organizations also conduct research, develop programs, deliver training, raise awareness and advocate on behalf of those most in need. Many communities in Canada also work to raise awareness and encourage safe conversations about suicide.

Suicide prevention in Canada requires a comprehensive approach that works across federal departments and brings together all levels of government in collaboration with researchers, communities and families.

This overview of current federal suicide prevention initiatives was created in the context of the development of a federal framework for suicide prevention. The framework will help better align federal activities in suicide prevention, while complementing the important work underway in provinces and territories, Indigenous organizations, non-governmental organizations and communities as well as the private sector.

Federal Initiatives in Suicide Prevention

Promoting and Protecting the Mental Well-being of Canadians

February 2016
ISBN : 978-0-660-02470-7
Cat. No. : HP35-60/2015E-PDF
HC Pub. : 150023

Alternative Formats

The Government of Canada promotes and protects the health of Canadians, including activities to promote mental health and well-being. Mental health and well-being enables people to better cope with the normal stresses and daily challenges of life so they can work and study productively and make positive contributions to their families and communities.

Federal departments undertake this role in different ways. For instance, the Public Health Agency of Canada promotes mental health and well-being by supporting programs that build resilience in individuals and communities to help overcome adversity. Federal public health activities focus on the most vulnerable and are aimed at all ages and life stages. An example of this ongoing commitment is the Public Health Agency of Canada's support for the Community Action Program for Children and the Canada Prenatal Nutrition Program. These programs address factors that affect mental health, such as parent and caregiver coping skills, peer support and post-partum depression and they help reduce risk factors for mental illness, suicide, family violence and substance misuse. The Public Health Agency of Canada is also testing and evaluating new mental health promotion programs as part of its Innovation Strategy to understand what works, why it works and in what context, for a variety of populations, including youth and parents. In addition, the Public Health Agency of Canada is supporting community-based projects that promote both the physical and mental health of survivors of family violence.

Poor mental health and suicide can impact Canadians at every stage of life. Seniors are no exception. Recognizing this, the Public Health Agency of Canada funded updates to a series of mental health guides for seniors and their families that will be used to share important mental health and suicide prevention information. The Public Health Agency of Canada has also developed a framework for positive mental health surveillance to provide information on positive mental health outcomes as well as associated risk and protective factors at the individual, family, community and societal levels. A framework for adults has been completed and the Public Health Agency of Canada is continuing efforts to develop frameworks for youth and for children.

Another important focus for the Government of Canada is sharing information that improves public awareness about possible suicide risk factors and ways to prevent suicide. For example, Transport Canada funded research that was the basis for a website on railway-related suicide and its prevention. Justice Canada has produced a public legal education brochure that addresses emotional issues associated with separation and divorce and provides information on where to seek help for depression. Employment and Social Development Canada offers support to community-based approaches for vulnerable populations that encourage Canadians to be actively involved in their communities, such as the New Horizons for Seniors Program. Finally, Service Canada developed guidelines for O-Canada telephone staff to direct Canadians in crisis to local services and supports.

The Mental Health Commission of Canada

The Government of Canada also supports the mental health needs of Canadians through the Mental Health Commission of Canada. In 2007, the federal government invested $130 million over 10 years to establish and support the Mental Health Commission of Canada as a catalyst for improving the mental health system.

The Mental Health Commission of Canada has stimulated public dialogue about mental health through its national Opening Minds campaign, which addresses stigma and raises awareness among health care providers, schools, workforces and the media. The Mental Health Commission of Canada works with its partners across Canada to facilitate conversations about suicide prevention, including sharing information about best practices. It has developed a successful toolkit for this purpose which is being adapted for use in a variety of communities and settings. In 2008, the Government of Canada allocated an additional $110 million towards At Home/Chez Soi, a research project that demonstrated the effectiveness of the "housing first" approach, where people are provided with a place to live and then offered recovery-oriented services and supports that best meet their individual needs.

The Mental Health Commission of Canada also informs policy development on suicide prevention by participating in various advisory committees that involve representatives from federal, provincial and territorial governments and non-governmental organizations. In 2012, the Mental Health Commission of Canada released Canada's first mental health strategy, Changing Directions, Changing Lives: The Mental Health Strategy for Canada. The Strategy outlines a plan to improve mental health for all Canadians and underscores the importance of suicide prevention. In 2014, the Mental Health Commission of Canada launched #308conversations, a national grassroots suicide prevention campaign that invites each of Canada's Members of Parliament (308 at the time) to lead a conversation with their constituents about suicide prevention. The campaign's toolkit is being adapted for use in other community settings. Also in 2014, the Mental Health Commission of Canada partnered with the Canadian Association for Suicide Prevention to host a virtual conference on suicide prevention, intervention and postvention.

The National Collaborative for Suicide Prevention

The Government of Canada collaborates with other partners on suicide prevention. The Public Health Agency of Canada co-chairs the National Collaborative for Suicide Prevention with the Canadian Association for Suicide Prevention and the Mental Health Commission of Canada. The goal of the National Collaborative for Suicide Prevention is to increase capacity for effective suicide prevention by connecting people, ideas and resources on a pan-Canadian level. Its members include representatives from social and health-based organizations that are invested in the promotion of mental health and the prevention of mental illness and suicide across Canada, including the Assembly of First Nations and the Inuit Tapiriit Kanatami. Current federal membership also includes the Canadian Institutes of Health Research, Health Canada and the federally-funded Canadian Centre on Substance Abuse.

Enhancing Mental Well-being in the Workplace

The Government of Canada supported the Mental Health Commission of Canada in the development of the world's first voluntary National Standard for Psychological Health and Safety in the Workplace. Launched in January 2013, the National Standard provides guidelines for Canadian employers so they can develop and continuously improve work environments for their employees in terms of psychological health and safety. The goal of the National Standard is to make it easier for Canadian employers to take steps to prevent mental injury, reduce psychological risk and promote a mentally healthier workplace.

At the 2014 meeting of Federal-Provincial-Territorial Ministers Responsible for Labour, Ministers committed to promote the National Standard as a best practice within their jurisdictions. The Government of Canada will continue to work with the Mental Health Commission of Canada to promote the use of the National Standard among private and public sector organizations across Canada and to develop tools and resources to assist employers in the implementation of the National Standard.

In March 2015, the Treasury Board Secretariat of Canada and the Public Service Alliance of Canada announced the creation of a Joint Task Force to improve mental health and safety in the federal public service. The Joint Task Force undertook to review the National Standard and identify how its objectives could best be achieved within the federal public service. The Mental Health Joint Task Force Report was released in December 2015, along with 11 recommendations around renewed leadership, engagement and education, as well as training and workplace practices, communication/promotion and accountability. These recommendations are complementary to a range of employer policies and activities that support employee mental health such as the federal Employee Assistance Program, Values and Ethics, employee disability plans and the Public Service Health Care Plan, in particular the recent increase in coverage for psychological services.

Programs for Specific Groups

Most mental health services for Canadians are provided or administered through provincial and territorial governments. However, the Government of Canada provides or funds direct mental health care services for specific groups, including Indigenous people living on reserve and in Inuit communities, serving members of the Canadian Armed Forces, Veterans, current and former members of the Royal Canadian Mounted Police, newcomers, and federally incarcerated individuals.

Serving Members of the Canadian Armed Forces

The Canadian Armed Forces has a comprehensive health care system, which sets mental health as one of its priorities. The mental health program includes education and health promotion, provision of clinical care and services and a research program to understand both the mental health burden within the population and ways to improve the care provided. The Canadian Armed Forces also conducts detailed investigations for each death by suicide providing vital details that ultimately lead to improvements in the quality of care and support for its personnel. The mental health program is guided by the Surgeon General's Mental Health Strategy: An Evolution of Excellence (2013) and is further informed by the recommendations from the Canadian Forces Expert Panel on Suicide Prevention (2010).

The Canadian Armed Forces provides a health promotion program known as Strengthening the Forces, which covers four major areas: addictions awareness and prevention; injury prevention and active living; nutritional wellness; and social wellness. One of the program's modules under social wellness is entitled Mental Fitness and Suicide Awareness. In addition, the Canadian Armed Forces has a separate mental health education and training program, Road to Mental Readiness, which is delivered at different points during a military member's career. The primary purposes of Road to Mental Readiness are to improve resilience, increase mental health literacy and to reduce stigma. Road to Mental Readiness also addresses suicide awareness.

The Canadian Armed Forces also maintains a website You're not alone - Mental Health resources for CAF members and families. This website has information on a range of support programs available to Canadian Armed Forces members and families such as the network of Integrated Personnel Support Centres, the Operational Stress Injury Social Support Program and several help lines. The website also has a video series that addresses mental health issues, including stigma and suicide.

Canadian Armed Forces Veterans, their Families and other Persons Eligible for Veterans Affairs Canada Services

Veterans Affairs Canada provides a variety of programs and services that support the health and well-being of Veterans, their families and other eligible persons. These programs and services address suicide risk and protective factors identified in Veterans Affairs Canada's evidence-based Suicide Prevention Framework for Canadian Veterans. Veterans Affairs Canada supports a continuum of mental health services to assist with operational stress injuries. An operational stress injury is any persistent psychological difficulty that results from operational duties, including anxiety, depression and post-traumatic stress disorder as well as a range of less severe conditions that impact daily functioning.

Diagnosis and treatment of operational stress injuries and other mental health conditions are provided through the national Operational Stress Injuries Clinic Network and a residential inpatient clinic at Ste. Anne's Hospital in Ste. Anne-de-Bellevue, Quebec. Veterans Affairs Canada utilizes a national network of approximately 4,000 registered mental health professionals who deliver mental health services to Veterans with operational stress injuries close to where they live and approximately 300 community clinical care managers who provide time-limited intensive case management services as needed. All Veterans Affairs Canada frontline staff members are trained in suicide crisis intervention screening and risk assessment.

The Operational Stress Injury Social Support Program, created in partnership with the Canadian Armed Forces, is a peer-based network offering support to Veterans, active Canadian Armed Forces members and their families that addresses stigma and increases awareness of operational stress injuries. The Veterans Affairs Canada Assistance Service provides a toll-free telephone and referral service, 24 hours a day, seven days a week. Veterans Affairs Canada is working with the Mental Health Commission of Canada to implement a Veteran-specific Mental Health First Aid course for Veterans, their families and caregivers. The course teaches recognition of signs and symptoms of common mental health disorders, crisis first aid for mental health conditions and where and how to get help.

These programs and services are complemented by the New Veterans Charter which provides case management, medical, psychosocial and vocational rehabilitation services, financial and health care benefits, disability awards and career transition services.

First Nation and Inuit Communities

Health Canada supports community-based suicide prevention projects and activities aimed at promoting protective factors, such as mental well-being and reducing risk factors which contribute to First Nations and Inuit youth suicide, through the National Aboriginal Youth Suicide Prevention Strategy. The National Aboriginal Youth Suicide Prevention Strategy is led by Health Canada's First Nations and Inuit Health Branch and was developed in partnership with Indigenous organizations. In 2014-15, the National Aboriginal Youth Suicide Prevention Strategy supported approximately 138 community-based projects in First Nation and Inuit communities across Canada. In a majority of regions, a request for proposals is issued and communities apply to access National Aboriginal Youth Suicide Prevention Strategy funding based on regional-specific criteria.

The National Aboriginal Youth Suicide Prevention Strategy

Below are two examples of projects supported by the National Aboriginal Youth Suicide Prevention Strategy.

The Battle River Treaty 6 Health Centre developed and delivers the school-based program Journey to Wellness. This eight-week program engages Aboriginal youth aged 10 to 18 in relationship-building, problem-solving, self-esteem and peer mentorship. The program includes a focus on mental health promotion and awareness through activities that explore facts and myths about suicide and how to manage life's setbacks. Since the Journey to Wellness program began in 2007, students have established closer relationships with peers and adults in their schools, enhanced their problem-solving skills and understanding of how to seek help for depression or suicide-related behaviour and increased their knowledge of available resources.

The Taiga Adventure Camps, for girls aged 11 to 17, throughout the Northwest Territories, provides leadership opportunities through outdoor skill camps. These camps empower girls to develop confidence, leadership skills and respect for others through a fun, personalized and supportive camp experience. Past participants have stepped forward as community leaders, become more involved and connected to their community and demonstrate coping skills and resilience.

Health Canada and the Public Health Agency of Canada also support health promotion programs that reach young First Nations, Inuit and Métis children through the Aboriginal Head Start Program (On Reserve and in Urban and Northern Communities). These programs are culturally-based and address factors that affect mental health, helping to reduce the risk of suicide. Culture is recognized as a key protective factor and, when culture is the foundation, these services and programs can be delivered in culturally relevant and safe ways.

The Assembly of First Nations partnered with Health Canada, Indigenous mental health leaders and other government departments to develop a First Nations Mental Wellness Continuum Framework. With the principle that First Nations culture is a foundation, it strengthens federal mental wellness programming in regions and communities. The Inuit Tapiriit Kanatami is also moving forward with the development of an Inuit Mental Wellness Framework. Health Canada's Territorial Health Investment Fund also supports suicide prevention, mental health promotion and mental wellness initiatives in the North.

The Health Services Integration Fund is a program under the First Nations and Inuit Health Branch of Health Canada that is focused on engineering improvements at the health systems level, specifically to integrate the publicly-funded health services which serve First Nations and Inuit to increase access to and improve the quality of those services. The Health Services Integration Fund funds time-limited projects that support multiple jurisdictions to work together to make services more effective, accessible and/or culturally relevant. Between 2010 and 2015, stakeholders from all 13 provinces and territories identified mental health and addictions as a top theme area for integration work, which led to 30 percent of Health Services Integration Fund projects being primarily focused on these issues.

Newcomers, including Refugees

Immigration, Refugees and Citizenship Canada's Settlement Program provides funding to service provider organizations to assist newcomers, including refugees, with settling and integrating in Canada. Under this program, Immigration, Refugees and Citizenship Canada supports mental health services that focus on prevention and health promotion, in addition to health-related referrals to community resources. This includes a variety of programs that promote the independence, health, recovery and community integration of persons with mental health and/or addiction challenges through advocacy, education, service bridging, needs assessment and referrals, information products and orientation sessions and the provision of a broad range of community-based and housing support services. In addition, programs also aim to enhance capacity-building through training settlement workers to identify mental health issues and make the appropriate referrals in the community.

In cases where newcomers require mental health interventions such as trauma counselling, the role of Immigration, Refugees and Citizenship Canada's service providers is limited to identification (e.g., through short-term counselling sessions) and appropriate referrals to formal health care services offered by the provinces and territories.

In addition, Immigration, Refugees and Citizenship Canada's Interim Federal Health Program provides limited and temporary coverage of health care benefits to certain groups, such as resettled refugees and refugee claimants who are not eligible for provincial or territorial health insurance. Among other health care services covered by the program, some beneficiaries are eligible for psychiatric care and psychological counselling.

Royal Canadian Mounted Police

The Royal Canadian Mounted Police promotes mental health awareness through a variety of mental health promotion and suicide prevention programs as well as communications strategies. In May 2014, the Royal Canadian Mounted Police launched a five-year Mental Health Strategy to guide its efforts and priorities in enhancing the health and safety of its employees. The strategy was informed by clinical and workplace experience--acknowledging that a large number of its employees are exposed to traumatic events--as well as the National Standard for Psychological Health and Safety in the Workplace.

Federally Incarcerated Individuals

Correctional Service Canada has adopted an interdisciplinary approach to managing suicide-related and self-injurious behaviour in the federal correctional environment and offers a continuum of mental health services. Individuals serving federal sentences who are at risk for suicide undergo an in-depth assessment, as well as subsequent intervention and monitoring. Intensive psychiatric hospital care, intermediate mental health care (i.e., for individuals who do not require hospital care but whose needs exceed the primary mental health care services available in federal penitentiaries) as well as transitional care for release back into the community are also available. Correctional Service Canada delivers suicide awareness and prevention workshops and peer support programs for federally incarcerated individuals. It also provides ongoing guidance and training to correctional staff for the appropriate care and custody of any incarcerated person experiencing mental health concerns, including those experiencing suicide-related behaviours.

These efforts build on the priorities from the federal-provincial-territorial Mental Health Strategy for Corrections in Canada as well as the Government of Canada's Mental Health Action Plan for Federal Offenders.

Government of Canada Employees and their Families

Most people who die by suicide are of working age and because of this, workplace well-being is an important consideration in suicide prevention. Employee assistance programs and related resources that are well promoted in workplaces can be effective in reaching people at risk of suicide.

On behalf of the Treasury Board of Canada Secretariat, Health Canada delivers 24-hour telephone assistance, professional solution-focused counselling and referral services for members of the Canadian Armed Forces, Veterans, current and former Royal Canadian Mounted Police members, employees of the federal public service and their families through the Employee Assistance Program. This includes support for mental and emotional health concerns as well as suicide-related crises.

Monitoring Suicide and Supporting Research on Suicide Prevention

Underpinning all suicide prevention efforts is the regular and systematic collection, analysis and dissemination of suicide-related data, as well as the generation of evidence through research activities. The Government of Canada both funds and conducts monitoring and research activities to better understand suicide in Canada, its risk and protective factors and how to effectively intervene.

Monitoring Suicide Trends

The Government of Canada, through the surveillance leadership of the Public Health Agency of Canada, supports information-sharing and expertise across government departments on suicide-related surveillance data and collaborates so that existing data can be used effectively to provide a more complete picture of suicide in Canada.

The Public Health Agency of Canada monitors suicide and self-harm through emergency department data, hospital administrative database, vital statistics and Statistics Canada health surveys. Some of these data are publically accessible through online interactive datacubes that make it possible for users to create tables and graphs of Canadian suicide statistics through their web browser. The Public Health Agency of Canada also collects data on the mental and emotional health of youth through the Health Behaviour in School Aged Children Survey.

Statistics Canada collects and disseminates mental health data through the Canadian Community Health Survey to improve understanding of factors that influence poor mental health, thoughts of suicide and suicide attempts. Statistics Canada's 2012 Canadian Community Health Survey - Mental Health collected data on thoughts of suicide, plans and attempts among the general population.

A number of other federal departments that serve specific populations, such as members of the Canadian Armed Forces, Veterans, people living in First Nations and Inuit communities and federally incarcerated individuals, also collect data on suicide and conduct research related to mental health and suicide prevention. These activities help inform the development of policies and programs.

Efforts are underway through the Mental Health and Addictions Information Collaborative, which is co-chaired by the Public Health Agency of Canada and the Mental Health Commission of Canada, to coordinate data collection and monitoring on topics related to mental health, mental illness, addictions and suicide, to respond to strategic priorities and prevent duplication of efforts.

Research to Better Understand Suicide Prevention

The Government of Canada supports and conducts a wide range of research that helps build evidence to enhance understanding of suicide and how to prevent it. Health Canada supports the Mood Disorders Society of Canada in the development of the Canadian Depression Research and Intervention Network which builds new connections and improves cohesion among Canada's mental health research community, service providers and persons living with depression and post-traumatic stress disorder.

Through the Canadian Institutes of Health Research, the Government of Canada supports and partners in mental health and addictions research, including suicide prevention and post-traumatic stress disorder, to inform mental wellness initiatives for Canadians. Since 2000, the Canadian Institutes of Health Research invested more than $47 million in research related to suicide.

The Canadian Institutes of Health Research's Signature Initiative Pathways to Health Equity for Aboriginal Peoples, developed in collaboration with the Public Health Agency of Canada and Health Canada's First Nations and Inuit Health Branch, provides $25 million in research funding over ten years in four priority areas related to Indigenous health, one of which is suicide prevention. The initiative aims to develop an evidence base on how to design, offer and implement programs and policies that promote health and health equity.

The Pathways to Health Equity for Aboriginal Peoples project is also linked to an initiative under the Arctic Council's Sustainable Development Working Group. The Government of Canada, through the Canadian Institutes of Health Research and the Public Health Agency of Canada, led the initiative from 2013 to 2015. Other participants included the Kingdom of Denmark, Norway, the Russian Federation, the United States and the Inuit Circumpolar Council. This initiative focused on suicide prevention intervention research in circumpolar communities to identify and share best practices in promoting resilience and well-being, particularly among children and youth. The initiative will be pursued and expanded under the current United States chairmanship.

The Canadian Institutes of Health Research also collaborates with provinces, territories and the Graham Boeckh Foundation to support research to address adolescent and youth mental health and well-being. The ACCESS Canada research network was launched under Canada's Strategy for Patient Oriented Research, led by the Canadian Institutes of Health Research, which is a key platform for jurisdictions to collaborate on health innovation. Developed in partnership with the Graham Boeckh Foundation, the goal of ACCESS Canada is to use evidence to bring about change in the care of young people with mental illness, including change to suicide prevention efforts. It is developing strategies to ensure more young people are connected to the mental health services they need and will move research evidence to the point of care so young people receive the best possible treatments available. Ultimately, the network will improve health outcomes for youth by transforming the way mental health care is provided in Canada.

Understanding Suicide in Specific Groups

Other federal departments undertake research to better understand the mental health needs of specific populations, such as Veterans, members of the Canadian Armed Forces and federally incarcerated individuals. For example, the Department of National Defence supported the 2013 Canadian Forces Mental Health Survey as well as an outcomes study on operational stress injury incidence. Veterans Affairs Canada examines suicide-related behaviours in Canadian Veterans (former Canadian Armed Forces members) on an ongoing basis and Correctional Service Canada collects data, investigates incidents of suicide and conducts research into self-injury and suicide.

Veterans Affairs Canada, the Canadian Armed Forces and Statistics Canada have collaborated on a number of studies that have contributed to the understanding of suicide-related behaviours in the Veteran population, including the Canadian Forces Cancer and Mortality Study (2011) and the Life After Service Studies program of research, including Life After Services Studies surveys conducted in 2010, 2013 and 2016. In addition, Veterans Affairs Canada and the Canadian Armed Forces are supporting research to find better treatments, promote faster recoveries and achieve better outcomes for Canadian Armed Forces Veterans with mental health conditions.

Veterans Affairs Canada is funding a new program of research called Road to Civilian Life that focuses on the stressful period around release from service. Individual members will be followed across military-civilian transition and a study will be conducted to better understand how to minimize the effects of operational stress injuries, including post-traumatic stress disorder. Another study is looking at how operational stress injuries affect families and the role families play in supporting Veterans with operational stress injuries and programs that support families.

Putting Knowledge into Practice

To ensure suicide prevention activities are most effective, research findings must be shared with communities, including frontline and community-based workers.

The Mental Health Commission of Canada's Knowledge Exchange Centre facilitates knowledge-sharing about suicide prevention best practices among mental health professionals and communities through webinars, conferences and online social media channels. The Mental Health Commission of Canada's Supporting the Promotion of Activated Research and Knowledge (SPARK) training workshop helps participants move research findings and knowledge from the fields of mental health, substance use and addictions into practice more quickly.

Health Canada, in partnership with the True Patriot Love Foundation and through the Canadian Institute for Military and Veteran Health Research, is supporting the uptake of research to better address the health and wellness of Canadian Armed Forces personnel, Veterans and their families, which will put research, knowledge and information into the hands of those who work closely with these groups.

Conclusion

Considerable work is underway throughout the Government of Canada to better understand and help prevent suicide.

The federal framework for suicide prevention will build on these initiatives and those of other levels of government, non-governmental organizations, Indigenous communities and organizations, as well as other individual communities to contribute to the prevention of suicide in Canada.

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